Residential relocation to assess impact of changes in the living environment on cardio-respiratory health: A narrative literature review with considerations for exposome research.

Residential relocation studies have become increasingly valuable tools for evaluating the effects of changing living environments on human health, but little is known about their application to multiple aspects of the living environment and the most appropriate methodology. This narrative review explores the utility of residential relocation as a natural experiment for studying the impact of changing urban exposures on cardio-metabolic health in high-income settings. It provides a comprehensive overview of the use of residential relocation studies, evaluates their methodological approaches, and synthesizes findings related to health behaviors and cardio-metabolic outcomes. Our search identified 43 relevant studies published between January 1995 and February 2023, from eight countries, predominantly the USA, Canada, and Australia. The majority of eligible studies were published between 2012 and 2021 and examined changes in various domains of the living environment, such as walkability, the built and social environments, but rarely combinations of exposures. Included studies displayed heterogeneity in design and outcomes, 25 involving only movers and 18 considering both movers and non-movers. To mitigate the issue of residential self-selection bias, most studies employed a "change-in-change" design and adjusted for baseline covariates but only a fraction of them accounted for time-varying confounding. Relocation causes simultaneous changes in various features of the living environment, which presents an opportunity for exposome research to establish causal relationships, using large datasets with increased statistical power and a wide range of health outcomes, behaviors and biomarkers. Residential relocation is not a random process. Thus, studies focusing on living environment characteristics need to carefully select time-varying covariates and reference group. Overall, this review informs future research by guiding choices in study design, data requirements, and statistical methodologies. Ultimately, it contributes to the advancement of the urban exposome field and enhances our understanding of the complex relationship between urban environments and human health.

The local impacts of coal and oil power plant retirements on air pollution and cardiorespiratory health in California: An application of generalized synthetic control method.

BACKGROUND: This study capitalized on coal and oil facility retirements to quantify their potential effects on fine particulate matter (PM2.5) concentrations and cardiorespiratory hospitalizations in affected areas using a generalized synthetic control method. METHODS: We identified 11 coal and oil facilities in California that retired between 2006 and 2013. We classified zip code tabulation areas (ZCTA) as exposed or unexposed to a facility retirement using emissions information, distance, and a dispersion model. We calculated weekly ZCTA-specific PM2.5 concentrations based on previously estimated daily time-series PM2.5 concentrations from an ensemble model, and weekly cardiorespiratory hospitalization rates based on hospitalization data collected by the California Department of Health Care Access and Information. We estimated the average differences in weekly average PM2.5 concentrations and cardiorespiratory hospitalization rates in four weeks after each facility retirement between the exposed ZCTAs and the synthetic control using all unexposed ZCTAs (i.e., the average treatment effect among the treated [ATT]) and pooled ATTs using meta-analysis. We conducted sensitivity analyses to consider different classification schemes to distinguish exposed from unexposed ZCTAs, including aggregating outcomes with different time intervals and including a subset of facilities with reported retirement date confirmed via emission record. RESULTS: The pooled ATTs were 0.02 µg/m3 (95% confidence interval (CI): -0.25 to 0.29 µg/m3) and 0.34 per 10,000 person-weeks (95%CI: -0.08 to 0.75 per 10,000 person-weeks) following the facility closure for weekly PM2.5 and cardiorespiratory hospitalization rates, respectively. Our inferences remained the same after conducting sensitivity analyses. CONCLUSIONS: We demonstrated a novel approach to study the potential benefits associated with industrial facility retirements. The declining contribution of industrial emissions to ambient air pollution in California may explain our null findings. We encourage future research to replicate this work in regions with different industrial activities.

Effects of air purification of indoor PM2.5 on the cardiorespiratory biomarkers in young healthy adults.

Ambient fine particulate matter (PM2.5 ), as one of the predominant air pollutants, has achieved effective control in recent years in China. Whether the use of indoor air purifiers is still necessary needs further exploration. A randomized crossover trial was conducted in 54 healthy students in Beijing, China. Participants were randomized assigned to the use of real or sham high-efficiency particulate air filter (HEPA) for a week and changed the status after a washout period. Health measurements of cardiorespiratory biomarkers were performed at the end of each period. Linear mixed-effects models were used to evaluate the association between PM2.5 exposure and cardiorespiratory biomarkers. Compared with sham air purification, average diastolic blood pressure (DBP), fractional exhaled nitric oxide (FeNO), and 8-isoprostane (8-isoPGF2α) levels decreased significantly in the real purification. The effects of indoor air purification on lung function indicators including forced expiratory volume in one second (FEV1 ), peak expiratory flow (PEF), and forced expiratory flow between the 25th and 75th percentile of forced vital capacity (FEF25%-75% ) were also significant. Our findings showed a protective effect of indoor HEPA air purifiers on cardiorespiratory health of young healthy adults reflected by the decreased blood pressure, respiratory inflammation, and systematic oxidative stress and improved lung function.

Adverse health impacts of cooking with kerosene: A multi-country analysis within the Prospective Urban and Rural Epidemiology Study.

BACKGROUND: Kerosene, which was until recently considered a relatively clean household fuel, is still widely used in low- and middle-income countries for cooking and lighting. However, there is little data on its health effects. We examined cardiorespiratory effects and mortality in households using kerosene as their primary cooking fuel within the Prospective Urban Rural Epidemiology (PURE) study. METHODS: We analyzed baseline and follow-up data on 31,490 individuals from 154 communities in China, India, South Africa, and Tanzania where there was at least 10% kerosene use for cooking at baseline. Baseline comorbidities and health outcomes during follow-up (median 9.4 years) were compared between households with kerosene versus clean (gas or electricity) or solid fuel (biomass and coal) use for cooking. Multi-level marginal regression models adjusted for individual, household, and community level covariates. RESULTS: Higher rates of prevalent respiratory symptoms (e.g. 34% [95% CI:15-57%] more dyspnea with usual activity, 44% [95% CI: 21-72%] more chronic cough or sputum) and lower lung function (differences in FEV1: -46.3 ml (95% CI: -80.5; -12.1) and FVC: -54.7 ml (95% CI: -93.6; -15.8)) were observed at baseline for kerosene compared to clean fuel users. The odds of hypertension was slightly elevated but no associations were observed for blood pressure. Prospectively, kerosene was associated with elevated risks of all-cause (HR: 1.32 (95% CI: 1.14-1.53)) and cardiovascular (HR: 1.34 (95% CI: 1.00-1.80)) mortality, as well as major fatal and incident non-fatal cardiovascular (HR: 1.34 (95% CI: 1.08-1.66)) and respiratory (HR: 1.55 (95% CI: 0.98-2.43)) diseases, compared to clean fuel use. Further, compared to solid fuel users, those using kerosene had 20-47% higher risks for the above outcomes. CONCLUSIONS: Kerosene use for cooking was associated with higher rates of baseline respiratory morbidity and increased risk of mortality and cardiorespiratory outcomes during follow-up when compared to either clean or solid fuels. Replacing kerosene with cleaner-burning fuels for cooking is recommended.

Growing up in Bradford: protocol for the age 7-11 follow up of the Born in Bradford birth cohort.

BACKGROUND: Born in Bradford (BiB) is a prospective multi-ethnic pregnancy and birth cohort study that was established to examine determinants of health and development during childhood and, subsequently, adult life in a deprived multi-ethnic population in the north of England. Between 2007 and 2010, the BiB cohort recruited 12,453 women who experienced 13,776 pregnancies and 13,858 births, along with 3353 of their partners. Forty five percent of the cohort are of Pakistani origin. Now that children are at primary school, the first full follow-up of the cohort is taking place. The aims of the follow-up are to investigate the determinants of children's pre-pubertal health and development, including through understanding parents' health and wellbeing, and to obtain data on exposures in childhood that might influence future health. METHODS: We are employing a multi-method approach across three data collection arms (community-based family visits, school based physical assessment, and whole classroom cognitive, motor function and wellbeing measures) to follow-up over 9000 BiB children aged 7-11 years and their families between 2017 and 2021. We are collecting detailed parent and child questionnaires, cognitive and sensorimotor assessments, blood pressure, anthropometry and blood samples from parents and children. Dual x-ray absorptiometry body scans, accelerometry and urine samples are collected on subsamples. Informed consent is collected for continued routine data linkage to health, social care and education records. A range of engagement activities are being used to raise the profile of BiB and to disseminate findings. DISCUSSION: Our multi-method approach to recruitment and assessment provides an efficient method of collecting rich data on all family members. Data collected will enhance BiB as a resource for the international research community to study the interplay between ethnicity, socioeconomic circumstances and biology in relation to cardiometabolic health, mental health, education, cognitive and sensorimotor development and wellbeing.

Physical rehabilitation program for cardiorespiratory health and quality of life among breast cancer survivors in UAE: protocol for a randomized control trial.

BACKGROUND: Cancer is a medical condition where some cells of the body reproduce uncontrollably and metastasize to other parts of the body. The burden of the disease is significantly high both at the global and national levels. In UAE, cancer was found to be the third leading cause of death. Breast cancer has been ranked first due to its prevalence, incidence, and mortality in UAE. Breast cancer survivors have significantly poor cardiovascular tolerance which affects their quality of life (QoL), even after the carcinoma has been treated or removed. Thus, the protocol aims to analyze the changes in cardiovascular endurance and QoL domains for breast cancer survivors in the United Arab Emirates using a long-term 2-month physical rehabilitation. METHODS: A total of 60 breast cancer survivors would be included in the study using a randomized controlled allocation of a 2-month physical rehabilitation intervention program with 3 months of follow-up. The intervention would target the cardiovascular endurance component of the participants to improve their physical well-being and quality of life ultimately. DISCUSSION: The findings of the study would have high clinical significance among breast cancer survivors in the UAE. The proposed physical rehabilitation program could be beneficial in improving cardiovascular endurance and thereby reduce the risk of mortality among breast cancer survivors. In addition, the physiological benefits of the exercise program could improve their quality-of-life domains including physical, mental, and social well-being. On a larger view, it could also help to reduce the economic burden on the health system due to associated complications. TRIAL REGISTRATION: ClinicalTrials.gov NCT06013527. Registered on 28 August 2023.

Hypertrophic cardiomyopathy or athlete's heart? A systematic review of novel cardiovascular magnetic resonance imaging parameters.

Hypertrophic cardiomyopathy (HCM) is a common cause of sudden cardiac death in athletes. Cardiac Magnetic Resonance (CMR) imaging is considered an excellent tool to differentiate between HCM and athlete's heart. The aim of this systematic review was to highlight the novel CMR-derived parameters with significant discriminative capacity between the two conditions. A systematic search in the MEDLINE, EMBASE and Cochrane Reviews databases was performed. Eligible studies were considered the ones comparing novel CMR-derived parameters on athletes and HCM patients. Therefore, studies that only examined Cine-derived volumetric parameters were excluded. Particular attention was given to binary classification results from multi-variate regression models and ROC curve analyses. Bias assessment was performed with the Quality Assessment on Diagnostic Accuracy Studies. Five (5) studies were included in the systematic review, with a total of 284 athletes and 373 HCM patients. Several novel indices displayed discriminatory potential, such as native T1 mapping and T2 values, LV global longitudinal strain, late gadolinium enhancement and whole-LV fractal dimension. Diffusion tensor imaging enabled quantification of the secondary eigenvalue angle and fractional anisotropy in one study, which also proved capable of reliably detecting HCM in a mixed athlete/patient sample. Several novel CMR-derived parameters, most of which are currently under development, show promising results in discerning between athlete's heart and HCM. Prospective studies examining the discriminatory capacity of all promising modalities side-by-side will yield definitive answers on their relative importance; diagnostic models can incorporate the best performing variables for optimal results.

Associations of parks, greenness, and blue space with cardiovascular and respiratory disease hospitalization in the US Medicare cohort.

Natural environments have been linked to decreased risk of cardiovascular disease (CVD) and respiratory disease (RSD) mortality. However, few cohort studies have looked at associations of natural environments with CVD or RSD hospitalization. The aim of this study was to evaluate these associations in a cohort of U.S. Medicare beneficiaries (∼63 million individuals). Our open cohort included all fee-for-service Medicare beneficiaries (2000-2016), aged ≥65, living in the contiguous U.S. We assessed zip code-level park cover based on the United States Geological Survey Protected Areas Database, average greenness (Normalized Difference Vegetation Index, NDVI), and percent blue space cover based on Landsat satellite images. Cox-equivalent Poisson models were used to estimate associations of the exposures with first CVD and RSD hospitalization in the full cohort and among those living in urban zip codes (≥1000 persons/mile2). NDVI was weakly negatively correlated with percent park cover (Spearman ρ = -0.23) and not correlated with percent blue space (Spearman ρ = 0.00). After adjustment for potential confounders, percent park cover was not associated with CVD or RSD hospitalization in the full or urban population. An IQR (0.27) increase in NDVI was negatively associated with CVD (HR: 0.97, 95%CI: 0.96, 0.97), but not with RSD hospitalization (HR: 0.99, 95%CI: 0.98, 1.00). In urban zip codes, an IQR increase in NDVI was positively associated with RSD hospitalization (HR: 1.02, 95%CI: 1.00, 1.03). In stratified analyses, percent park cover was negatively associated with CVD and RSD hospitalization for Medicaid eligible individuals and individuals living in low socioeconomic status neighborhoods in the urban population. We observed no associations of percent blue space cover with CVD or RSD hospitalization. This study suggests that natural environments may benefit cardiorespiratory health; however, benefits may be limited to certain contexts and certain health outcomes.

Short-term effects of personal exposure to temperature variability on cardiorespiratory health based on subclinical non-invasive biomarkers.

Growing literatures have explored the cardiorespiratory health effects of the daily temperature, but such effects of temperature variability remain unclear. We investigated the acute associations of personal levels of temperature variability with cardiorespiratory biomarkers. This is a panel study with four repeated measurements among forty eligible college students in Hefei, Anhui Province, China. We collected personal-level temperature data using temperature/humidity data loggers. Temperature variability parameters included diurnal temperature range (DTR), the standard-deviation of temperature (SDT) and temperature variability (TV). Cardiorespiratory health indicators included three BP parameters [systolic BP (SBP), diastolic BP (DBP) and mean article pressure (MAP)], fractional exhaled nitric oxide (FeNO), and four saliva biomarkers [C-reactive protein (CRP), cortisol, alpha-amylase and lysozyme]. Linear mixed-effect models were then used to assess the associations of temperature variability with these cardiorespiratory biomarkers. We found that short-term exposure to the three temperature variability parameters was associated with these cardiorespiratory biomarkers. The magnitude, direction and significance of these associations varied by temperature variability parameters, by biomarkers and by lags of exposure. Specifically, temperature variability parameters were inversely associated with BP and saliva lysozyme; positively associated with airway inflammation biomarkers (FeNO and saliva CRP) and stress response biomarkers (saliva cortisol and alpha-amylase). The results were robust to further control for air pollutants, and these associations were more prominent in females and in subjects with abnormal body mass index. Our findings suggested that acute exposure to temperature variability could significantly alter cardiorespiratory biomarker profiles among healthy young adults in China.

The physiological and perceptual responses of stand-up paddle board exercise in a laboratory- and field-setting.

This study quantified the physiological and perceptual responses of stand-up paddle boarding (SUP) during a range of stroke rates in a laboratory- and field-setting. Ten participants (eight male, two female; mean ± standard deviation [SD] age: 23 ± 3 years; body mass: 70.5 ± 9.1 kg; height: 170 ± 9 cm; body mass index [BMI]: 24.3 ± 1.5 kg m2) completed a SUP ⩒O2peak trial, and two SUP trials in both a laboratory- and field-setting (5-min at 10, 20 and 30 strokes min-1 per stage). Energy expenditure (EE), metabolic equivalents (METs), heart rate (HR) and rating of perceived exertion (RPE) were recorded throughout. In the laboratory-setting, mean ± SD EE and METs increased (P < .001) linearly when SUP at 10 (3.3 ± 1.0 kcal min-1, 2.7 ± 0.5), 20 (5.5 ± 0.9 kcal min-1, 4.4 ± 0.7) and 30 strokes min-1 (7.6 ± 1.6 kcal min-1, 6.1 ± 1.2), respectively. During these efforts, mean ± SD percentage of maximal HR were 56 ± 5%, 69 ± 6% and 84 ± 8%, respectively. In the field-setting, mean ± SD EE and METs also increased (P < .001) linearly when SUP at 10 (3.6 ± 0.9 kcal min-1, 2.7 ± 0.9), 20 (4.3 ± 1.8 kcal min-1, 3.5 ± 1.0) and 30 strokes min-1 (6.3 ± 2.1 kcal min-1, 4.6 ± 1.4). During the three conditions, mean ± SD percentage of maximal HR were 58 ± 8%, 65 ± 7% and 73 ± 9%. SUP at ≥20 strokes min-1 in the laboratory- and field-setting meet the criteria for moderate-intensity exercise (3.0-5.9 METs). These findings may now be included in the latest Compendium of Physical Activities guidelines and offer the potential to improve cardiorespiratory fitness if SUP is undertaken regularly by young, healthy adults.

Enhancing indoor air quality -The air filter advantage.

Air pollution has become the world's single biggest environmental health risk, linked to around 7 million deaths in 2012 according to a recent World Health Organisation (WHO) report. The new data further reveals a stronger link between, indoor and outdoor air pollution exposure and cardiovascular diseases, such as strokes and ischemic heart disease, as well as between air pollution and cancer. The role of air pollution in the development of respiratory diseases, including acute respiratory infections and chronic obstructive pulmonary diseases, is well known. While both indoor and outdoor pollution affect health, recent statistics on the impact of household indoor pollutants (HAP) is alarming. The WHO factsheet on HAP and health states that 3.8 million premature deaths annually - including stroke, ischemic heart disease, chronic obstructive pulmonary disease (COPD) and lung cancer are attributed to exposure to household air pollution. Use of air cleaners and filters are one of the suggested strategies to improve indoor air quality. This review discusses the impact of air pollutants with special focus on indoor air pollutants and the benefits of air filters in improving indoor air quality.